June 17, 2005

Childbirth at Home as Safe as Hospital Delivery

Women who choose to give birth at home with the help of a certified midwife have deliveries that are as safe as those done in a hospital, Canadian researchers report.

"Home birth is a reasonable option for low-risk women," said lead researcher Kenneth C. Johnson.

"In this low-risk group of women who had births with midwives at home, we found that the overall safety was similar to what you would find in a hospital in a similar low-risk group," added Johnson, a senior epidemiologist with the Center for Chronic Disease Prevention and Control at the Public Health Agency of Canada, in Ottawa.

Moreover, evidence from the study supports the American Public Health Association's recommendation that home deliveries with certified midwives should be increased in the United States, he said.

The study appears in the June 18 issue of the British Medical Journal.

Johnson and colleague Betty-Anne Daviss collected data on over 5,400 women who had planned to deliver their babies at home in 2000. These women all had the help of a certified midwife.

When it came time to deliver, 655 of the women transferred to the hospital instead at the start of labor, the researchers reported. "Only about 3 percent of these women had what the midwife perceived as an urgent transport," Johnson said. "The outcomes of these transfers turned out to be fine, by and large."

For the remaining women who had a home delivery, the death rate of newborns was 1.7 per 1,000 planned home births. This rate is similar to that of low-risk home and hospital births shown in other studies done in North America, the researchers noted.

Johnson pointed out that in Canada and Europe, midwives deliver most babies. "It's only in the United States among developed countries that midwives are still involved in only a very small percent of deliveries, and that home birth is rare and unacceptable to the obstetric and gynecology profession," he said.

Despite these findings, one expert thinks home delivery is not a good idea. "I am not a big fan of home deliveries," said Dr. Rachel Masch, an assistant professor of obstetrics and gynecology at New York University School of Medicine.

"I understand why women want to have them," she said. "And I understand that the literature we have today supports that there isn't any worse outcome for them versus the low-risk hospital delivery if you are screened properly. Although, as an obstetrician who sees a lot of things that happen bad quickly, I think that I have somewhat of a jaded view," Masch said.

Masch is concerned that when complications set in, they do so quickly and need immediate attention. Women who appear to be at low-risk can fall prey to problems during birth that weren't anticipated, or may have conditions that were not known, which can affect the delivery. Being in a hospital allows these women to get immediate care, which can save their lives and their babies' lives, she said, adding, "There are examples that I see frequently."

But another expert finds nothing but positives in increasing the numbers of home deliveries.

"The data we have so far suggests that over-medicalizing the process of labor and delivery adds cost without improving outcomes," said Dr. David L. Katz, director of the Prevention Research Center and an associate clinical professor of epidemiology and public health at Yale University School of Medicine.

"Building the option of home birth into the routine of obstetrical care for women at low risk of complications is worthy of serious consideration," he added.